Disparities are prevalent in many aspects of healthcare — in everything from birth outcomes to rates of asthma. New research from the University of Minnesota suggests race may also influence the care of patients with brain tumors.
Specifically, the research found that when a person presents with a brain tumor, their race may influence whether doctors recommend surgery to remove the tumor — or not to.
The research, published in the Lancet in December, found Black patients had higher odds of recommendation against surgical removal in the four most common brain tumors.
“We were very interested and inspired by recent events in the Twin Cities to take a look at how different demographics might affect the care of patients with brain tumors, said Andrew Venteicher, an assistant professor in the Department of Neurosurgery at the University of Minnesota and a member of the research team. “We were inspired to look at contributors to inequality in healthcare delivery, and this exists in many medical and surgical fields, and that’s been well studied.”
Instead of looking at patient survival rates, the team looked at rates that patients were recommended for surgery in hopes of finding evidence of unrecognized bias among treatment teams, he said.
To do so, they relied on data from public national registries, like the Surveillance, Epidemiology, and End Results (SEER) and National Cancer Databases (NCDB) that record patients with a new diagnosis of cancer. Between the two registries, the research looked at around 600,000 patients.
“That’s really the power of using these national registries. That data set of 600,000 patients with the most common brain tumors allowed us to ask whether patient demographics such as race or ethnicity correlate with receiving a recommendation for surgery by their treatment team,” Venteicher said.
The data showed being Black was associated with a decreased recommendation rate for surgery for the four most common intracranial tumors, Meningioma, Glioblastoma, Pituitary adenoma and Vestibular schwannoma.
So they then looked at the other database and found the same trend: Black people had decreased rates of recommendation for surgery among those with brain tumors.
The researchers controlled for other variables, like age, gender, and tumor size, and still found that the gap in recommendations for surgery is still significant, Venteicher said.
A deeper understanding
Recommendations for removal heavily depend on the type of tumor a patient has. In some cases, like with glioblastoma, removal is a key part of the treatment plan– and according to the data, removal of that particular tumor happens at lower rates for Black people.
“With glioblastoma, it’s a very aggressive cancer. So indeed, the standard of care is surgical resection when it’s safe to do that,” he said. “One could infer from that that it could potentially have an effect on outcomes.”
The next step Venteicher says would be to analyze the ramifications of lower surgery recommendation rates on outcomes. The team is also interested in looking at a smaller scale – for example conducting research among their own care team, to see if the same trend is true.
“We looked very nationally across the data and we don’t know exactly what environments this may be happening in. Big hospitals, small hospitals, urban hospitals, rural hospitals, et cetera,” he said. “It’d be nice to work towards a better understanding of how things like this might happen and whether this is happening at particular institutions.”